Browsing by Author "de Silva, A.H.W."

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Adaptation of "Medical Interview Satisfaction Scale" (MISS-21) for Sri Lankan general practice
(Sri Lanka Medical Association, 2019) de Silva, A.H.W.; Kasturiratne, K.T.A.A.; Seneviratne, A.L.P.; Wickremasinghe, A.R.
INTRODUCTION & OBJECTIVES: Patient satisfaction is an important clinical outcome and a validated Sinhalese tool to measure it is essential. MISS 21 is a tool validated in the British general practice. Objective was to translate, cross-culturally adapt and validate the MISS 21 to for the Sri Lankan Sinhala speaking general practice setting. METHODS: The suitability and relevance of items in MISS-21 were assessed and unacceptable items revised. Translation process involved back translations and synthesis. Conceptual and linguistic equivalence was considered. Accuracy in rephrasing-and semantic adjustments was made following pretest. Operational equivalence was evaluated. A sample size of 300 was estimated and 480 recruited to account for non-respondents. Tool was self-administered amongst literate Sinhala patients of ≥18 years from six general practices. Exploratory factor analysis (EFA) extracted potential components associated with satisfaction. Internal consistency was assessed using Cronbach's alpha. RESULTS: Sixteen items fulfilled 80% acceptance. Four items were retained unchanged on consensus while one item was changed. Operational equivalence was accepted. Only 381 were complete enabling EFA. EFA extracted two components. This model explained 56% of the variability of total patient satisfaction scores. Items exploring communication and distress releasing aspects loaded on component 1 ("communication and comfort"). Items related to unmet expectations of patients and the doctor's regard loaded on component 2 ("regard and clarity"). All items in components 1 and 2 (Cronbach's alpha >0.9 and >0.7) demonstrated good internal consistency. CONCLUSION: The Sinhala version of MISS 21 exhibited high content validity, satisfactory construct validity with an acceptable factor structure, internal consistency and high response rates.
Awareness of human papillomavirus, cervical cancer and its prevention among primigravid antenatal clinic attendees in a tertiary care hospital in Sri Lanka: a cross-sectional study
(Collingwood, Vic. Australia : CSIRO Publisher, 2019) de Silva, A.H.W.; Samarawickrema, N.; Kasturiratne, A.; Skinner, S. R.; Wickremasinghe, A.R.; Garland, S. M.
ABSTRACT: Background Cervical cancer is the second commonest cancer amongst Sri Lankan women. With introduction of the human papillomavirus (HPV) vaccine to the national immunisation schedule, awareness and prevention of disease underpins vaccine uptake. Knowledge of HPV, HPV-related diseases and attitudes towards prevention and screening among urban women was assessed. METHODS: Primigravids attending Colombo North Teaching Hospital antenatal clinics were recruited over 8 months as surrogates for women who have recently become sexually active. Data through a self-administered questionnaire on three domains were collected (cervical cancer, Pap testing, HPV and vaccine). RESULTS: Of 667 participants (mean age 23.9 (s.d. = 4.4) years, 68.0% (n = 454) had >11 years of schooling), only 1.5% (n = 10) were aware of all three domains: 55.0% (370/667) had heard of cervical cancer, 19.0% of whom (70/370) knew it was sexually acquired, 9.0% (60/667) were aware of Pap screening, while 5.4% (36/665) had heard about HPV and <1.0% (5/667) knew it caused cancer. The total knowledge score ranged from zero (379/665) to nine (2/665), with a mean of 0.9 (s.d. - 1.4), with awareness increasing with level of education (χ2 = 18.6; P <0.001). Of those aware of Pap testing, 8.0% (5/60) were reluctant to undergo testing, while 46.6% (28/60) had no apprehension. CONCLUSIONS: Knowledge of cervical cancer, Pap testing, HPV and vaccine was low, especially in terms of HPV. Among those aware of Pap screening, generally there were favourable attitudes to having a test. These data have implications for acceptance of the vaccine and any future expansion of cervical screening with newer, more cost-effective technologies.
Development of a knowledge sharing tool based on medical students' preferences to enhance clinical learning at the University Family Medicine Clinic, Ragama
(Sri Lanka Medical Association., 2019) de Silva, A.H.W.; Ranaweera, R.K.R.V.; Madurawala, C.S.I.
INTRODUCTION & OBJECTIVES: Teaching common clinical presentations is a primary objective during the 4th year 4-week Family Medicine rotation. Sharing new clinical knowledge becomes vital as only two students can be accommodated per consultation. Our objective was to develop a tool for students to share knowledge obtained during consultations. METHODS: Three successive student groups (averaging 20) contributed to the development of the tool. At the end of rotations, the provided feedback/suggestions, based on which the tool was improved Group_ 1 Students shared knowledge by posting questions based on new learning at consultations on a wall mount quiz board (WMQB) using sticky notes. Group_2 based on Group_1 students' preference, E-quiz board (EQB) was introduced to post questions. WhatsApp was the preferred platform for the EQB. Guideline on netiquette was uploaded on EQB. Group_3 based on suggestions from Group_2, students were requested to post questions with answers as text, web link or photograph. RESULTS: Most students of Group_1 (75%) preferred an online tool for knowledge sharing. WhatsApp (75%), Viber (15%) and faculty's virtual learning environment (10%) were electronic platform preferences WMQB was interesting for 90%, EQB for 71 % and EQB with answers for 95%. WMQB was helpful in sharing knowledge for 75%, EQB for 90% and EQB with answers for 100%. 65% agreed that WMQB encouraged reading while 52% for EQB and 76% for EQB with answers. Three students (n=42) experienced technical difficulties and one lacked a device to access EQB. CONCLUSION: WMQB and EQB were both acceptable for knowledge sharing. Introducing answers increased usefulness.
Domain-Specific learning among medical students
(Basic Medical Scientists Association, 2012) Perera, D.; Ramanayake, R.P.J.C.; de Silva, A.H.W.; Sumanasekara, R.D.N.; Jayasinghe, L.R.; Gunasekara, R.; Chandrasiri, P.
Background: The aim of this study was to investigate undergraduate medical student’s domain-specific learning. Method: The research tool was a structured essay question formulated to assess factual and affective knowledge and application and synthesis of knowledge .The question was administered to 151 students. Results: Mean score on the recall question was significantly higher than the other two domains. Total scores of female students were significantly higher than male students (P<0.05). Gender-wise difference in scores was not significant in any specific domain area. There was no significant relationship between factual knowledge and total scores. However, there was a significant linear relationship between total scores and the two areas of affective knowledge (r=0.78) and application and synthesis of knowledge (r=0.6). Findings indicate that affective knowledge and application of knowledge are closely related to overall acquisition of knowledge (P<0.0005). Conclusion: Teaching and assessment in higher-order knowledge domains and affective knowledge needs to be developed. Questions dealing with affective knowledge and testing higher-order cognitive abilities are more discriminatory than questions testing at the recall level.
Evaluation of teaching and learning in family medicine by students: a Sri Lankan experience
(Medknow, 2015) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Gunasekara, R.; Chandrasiri, P.
BACKGROUND: Family Medicine occupies a prominent place in the undergraduate curriculum of the Faculty of Medicine, University of Kelaniya, SriLanka. The one month clinical attachment during the fourth year utilizes a variety of teaching methods. This study evaluates teaching learning methods and learning environment of this attachment. METHODOLOGY: A descriptive cross sectional study was carried out among consenting students over a period of six months on completion of the clinical attachment using a pretested self administered questionnaire. RESULTS: Completed questionnaires were returned by 114(99%) students. 90.2% were satisfied with the teaching methods in general while direct observation and feed back from teachers was the most popular(95.1%) followed by learning from patients(91.2%), debate(87.6%), seminar(87.5%) and small group discussions(71.9%). They were highly satisfied with the opportunity they had to develop communication skills (95.5%) and presentation skills (92.9%). Lesser learning opportunity was experienced for history taking (89.9%), problem solving (78.8%) and clinical examination (59.8%) skills. Student satisfaction regarding space within consultation rooms was 80% while space for history taking and examination (62%) and availability of clinical equipment (53%) were less. 90% thought the programme was well organized and adequate understanding on family medicine concepts and practice organization gained by 94% and 95% of the students respectively. CONCLUSIONS: Overall student satisfaction was high. Students prefer learning methods which actively involve them. It is important to provide adequate infrastructure facilities for student activities to make it a positive learning experience for them.
Knowledge and attitudes on Cervical Cancer and Its prevention amongst primigravid women
(Sri Lanka Medical Association, 2014) de Silva, A.H.W.; Kasturiratne, A.; Subasinghe, V.; Samarawickrema, N.; Garland, S.M.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To describe knowledge and attitudes on cervical cancer and its prevention amongst primigravid women METHODS: A descriptive cross-sectional study was conducted amongst primigravid women aged 18-35 years attending the antenatal clinics of Colombo North Teaching Hospital in 2013. Data were collected using a pretested self-administered questionnaire on their booking visit. RESULTS: 667 participated in the study. Mean age (SD) was 23.9 (4.4) years. Majority (67.5%) had passed G.C.E. Ordinary Level. 30% had heard about cervical cancer but only 11% knew of its viral aetiology.40% identified cervical cancer as a common cancer in Sri Lanka. 8% considered it to be familial and only 15% knew its transmissibility through sex. Knowledge on human papilloma virus (HPV) was very low. 9% had heard about the Papanicolaou test while only 50% of them knew that it could detect cervical cancer at a treatable stage. Only 5.4% had heard about HPV and 5.8% about a vaccine against HPV. Of the respondents who have heard about HPV 70% (21/39) knew that the infection can be prevented by a vaccine.10.5% strongly accepted undergoing periodical Papanicolaou tests as a good health practice while 45% did not know to comment. 21% had no fear but 5% felt embarrassed to participate in testing. Oniy 21% accepted it as a safe test. The association between the level of education and the knowledge of public health importance of cervical cancer was statistically significant (p=0.02). CONCLUSIONS: Knowledge on cervical cancer and preventive methods are low amongst primigravid women. Attitude towards the Papanicolaou test is poor.
Knowledge on HIV prevention amongst a group of post war re-settlers in Sri Lanka
(Sri Lanka College of Venereologits, 2015) de Silva, A.H.W.; Rizwaan, M.S.A.; Ramanayake, P.J.C.; Perera, D.P.; Sumanasekara, R.D.N.
BACKGROUND: The war that prevailed for the past three decades in the North and East of Sri Lanka impeded HIV prevention activities in these areas. The purpose of this study is to assess knowledge on HIV prevention amongst post war re-settlers in Thallavadi-Elephant Pass; Northern Province, Sri Lanka. OBJECTIVE: This study assesses the knowledge on HIV prevention amongst post war re-settlers attending a health awareness programme in the community.METHODS: Descriptive cross sectional study was carried out on 27th January 2012, using a pretested selfadministrated questionnaire amongst all consenting participants before commencement of the educational activities. All questions were close ended and replies were based on three answers-Yes/No/Don't know. No details of identification were included in the questionnaire and responders were requested to place the filled questionnaire in a sealed box to ensure anonymity. Responders who have never heard of HIV were excluded on analysing knowledge on HIV.RESULTS: One hundred and twelve post war re-settlers took part in the health awareness programme and 81(54% males) submitted the filled questionnaire. Seventy one (87%) respondents had heard of HIV. Only 14% identified that a HIV infected person may look healthy. fylajority 70% knew that treatment can improve quality of life of infected persons. 94% recognized condoms as a HIV prevention method.CONCLUSION: 17% of participants answered c01Tectly to all four variables of the UN GASS indicator 13: knowledge on HIV. The knowledge on HIV prevention amongst this group of post war re-settlers is very low.
Knowledge on HIV prevention amongst a group of post war re-settlers in Sri Lanka
(Sri Lanka College of Venereologists, 2014) de Silva, A.H.W.; Rizwaan, M.S.A.; Ramanayake, R.P.J.C.; Perera, D.P.; Sumanasekara, R.D.N.
BACKGROUND: The war that prevailed for the past three decades in the North and East of Sri Lanka impeded HIV prevention activities in these areas. The purpose of this study is to assess knowledge on HIV prevention amongst post war re-settlers in Thallavadi-Elephant Pass; Northern Province, Sri Lanka. OBJECTIVE: This study assesses the knowledge on HIV prevention amongst post war re-settlers attending a health awareness programme in the community. METHODS: Descriptive cross sectional study was carried out on 27th January 2012, using a pretested selfadministrated questionnaire amongst all consenting participants before commencement of the educational activities. All questions were close ended and replies were based on three answers-Yes/No/Don't know. No details of identification were included in the questionnaire and responders were requested to place the filled questionnaire in a sealed box to ensure anonymity. Responders who have never heard of HIV were excluded on analysing knowledge on HIV. Results: One hundred and twelve post war re-settlers took part in the health awareness programme and 81(54% males) submitted the filled questionnaire. Seventy one (87%) respondents had heard of HIV. Only 14% identified that a HIV infected person may look healthy. fylajority 70% knew that treatment can improve quality of life of infected persons. 94% recognized condoms as a HIV prevention method. CONCLUSION: 17% of participants answered c01Tectly to all four variables of the UN GASS indicator 13: knowledge on HIV. The knowledge on HIV prevention amongst this group of post war re-settlers is very low.
Morbidity pattern and process of care at a teaching hospital outpatient department in Sri Lanka
(Sri Lanka Medical Association, 2017) Mendis, K.; de Silva, A.H.W.; Perera, D.P.; Withana, S.S.; Premasiri, B.H.S.; Jayakodi, S.
INTRODUCTION & OBJECTIVES: There is paucity of published data regarding outpatient department (OPD) morbidity in spite of 55 million OPD visits to government hospitals in 2014. OPD morbidity has been assumed to be similar to indoor morbidity for two decades. The recent Ministry of Health focus to strengthen primary care skills of medical graduates, requires reliable data from primary care to align medical curricula towards this goal. This is an initial step to identify the primary care morbidity profile. METHODS: In a cross-sectional pilot study doctors trained as data collectors observed a representative sample of doctor patient encounters and recorded the reason for encounters (RFE) and process of care. The problem definition (PD) was provided by the consulting doctor. RFEs and PDs were later coded using International Classification of Primary Care (ICPC2). Analysis was done using ‘R Ver3.2.3’ programming language. RESULTS: A total of 2923 clinical encounters resulted in 5626 RFEs and 3051 health problems. Patients mean age was 39.1(±22) with 64.5% females. Top ranking PDs were (n=3051): acute upper respiratory infection (11.3%), other respiratory infection (8.1%), viral fever (4.7%), lower respiratory tract infection (4.7%), muscle symptoms and complaints (3.8%), gastritis (3.3%), bronchial asthma (2.6%), dermatitis (2.5%), fungal infections (1.6%) back pain (1.5%), sinusitis (1.4%), joint pains (1.2%) and tonsillitis (1.2%). Psychological problems accounted for 0.4% and no social problems were recorded. During 2923 encounters, 540 (18%) were referred to clinics and 66 (2.3%) admitted to hospital. Prescriptions were issued for 2349 (80%), examination carried out in 2322 (79%), advice given to 946 (32%) and investigations ordered for 348 (12%). CONCLUSION: The morbidity pattern of OPD patients is different from inpatients - almost two thirds were females and more than 30% were respiratory problems.
Patient held medical record: solution to fragmented health care in Sri Lanka.
(Lahore Institute of Public Health (LIPhealth), 2013) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.
Sri Lanka has an extensive network of health care institutions, but there is no registered population for any particular health care institution. Patients are free to select which doctor to consult and which hospital to get admitted. Also there is no established referral and back referral system in practice. This free movement of patients within and between the primary, secondary and tertiary levels of care by patient's choice has given rise to a situation where each episode of an illness or disease process is managed by different doctors in differing specialties. As in most care settings, the patient's medical or health record is held by the health service or doctor that is providing care to the patient for a specific ailment. This leads to a gap in communication between multiple caregivers leading to poor co-ordination of care. These difficulties faced and lessons learnt suggest the use of a medical record that is kept with the patient. Patient Held Medical Records (PHMR) are formal and structured records that are given to patients to enable the continuity and quality of care which he takes with him when he goes for medical consultations. PHMRs aim to improve communication between patients and the multiple clinicians and health care workers who are involved in patient management. The PHMR we propose comprises of a folder, clinical notes, problem list, flow sheet and other optional items. The PHMR can be used as a tool to empower and educate the patients. It will improve transparency and trust and facilitate continuity of care. Increased work load, cost, restriction of freedom in writing notes, confidentiality and retention of records by patients are the disadvantages which need consideration.
Rate of stunting among a sample of postwar resettled families in the Vanni region: a study from the Mullativu District
(Sri Lanka Medical Association, 2013) Ramanayake, R.P.J.C.; Sumanasekera, R.D.N.; de Silva, A.H.W.; Perera, D.P.; Chandrasiri, P.; Gunasekera, R.; Jayasinghe, L.R.
The Department of Family Medicine, University of Kelaniya conducted a health camp in Puthukudiyiruppu in March 2011. Height and weight measurements were carried out and data of 303 participants were analysed. The rate of stunting among children below six years in this population was 62% compared to 19.3% nationally. Thirty four percent of children and adolescents (6-18yrs) were underweight and 21.4% of adults had a BMI less than 18.5kg/m2.
Referral Communications in Sri Lanka; Views of General Practitioners
(SciRJ, 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.
INTRODUCTION: Referral of patients to specialists and hospitals is an essential and inevitable aspect of primary health care. Maintain good communication is essential during the process in order to provide quality care without delays and unnecessary expenses. In Sri Lanka referral letter from a general practitioner (GP) is not essential to get admitted to a hospital or to consult a specialist and there is no registered population for a particular practitioner. This study was conducted to look at the views of general practitioners on referral communications. METHODOLOGY: This was a descriptive cross sectional study and postal survey was conducted among members of the college of general practitioners of Sri Lanka using a self administered structured questionnaire. RESULTS: Response rate was 28.7%. Only less than 60% wrote a referral letter always when referring a patient to a hospital/ specialist and the main reasons were; Patients insistence on referral without an indication, No feedback from specialists and lack of ownership to non regular patients. Information related to the disease and administrative details were the items of information mainly included in letters while socio psychological items were given lesser importance. Reply rate was very poor irrespective of the referral destination and main items of information expected in a reply letter were; Diagnosis, plan of management and instructions to the GP. DISCUSSION: There should be better communication and coordination between GPs and specialists/hospital doctors. Ways and means should be explored and rectifying measures should be undertaken which will benefit patients, GPs, specialists/hospital doctors and the health care system.
Referral communications: Bridging the gap between primary care doctors and specialists
(Lesley Pocock medi+WORLD International, 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Lakmini, K.M.S.; Ranasinghe, B.L.S.
INTRODUCTION: In the Sri Lankan health system there is no system for registering a patient under any health care provider and there is no established referral and back referral system in practice. Still there is communication between primary care doctors and specialists mostly through conventional letters. This study was conducted to explore views of specialists on the referral process of the country. METHODOLOGY: This was a descriptive cross sectional study. A self-administered questionnaire based on the data gathered in earlier qualitative, explorative research was prepared to gather data. A postal survey was conducted among Specialists Island wide. RESULTS: 1100 specialists were included in the study and the response rate was 20%. Although specialists expect a referral letter from general practitioners they receive one only around 50% of the occasions. They were not happy with the quality of letters and expected a comprehensive referral letter. They were keen to reply but time constraints (50%), lack of secretarial support (36%) and perception that reply will not reach the sender (31%) were obstacles in replying. Continuous medical education, use of structured referral forms and strengthening training programs were suggested to improve communications. CONCLUSIONS AND RECOMMENDATIONS: Specialists have a positive attitude towards their professional relationship with GPs and they should be made aware of this and try to enhance their communication with specialists. There should be rectifiable measures in the systems which facilitate coordination and communication between the two parties and then the referral process will become meaningful and beneficial to all the stakeholders.
Referral letter with an attached structured reply form: Is it a solution for not getting replies
(Mumbai : Medknow, 2013) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.; Jayasinghe, L.R.; Fernando, K.A.T.; Athukorala, L.A.C.L.
Background: Communication between primary care doctors and specialists/hospital doctors is vital for smooth functioning of a health care system. In many instances referral and reply letters are the sole means of communication between general practitioners and hospital doctors/specialists. Despite the obvious benefits to patient care, answers to referral letters are the exception worldwide. In Sri Lanka hand written conventional letters are used to refer patients and replies are scarce. Materials and Methods: This interventional study was designed to assess if attaching a structured reply form with the referral letter would increase the rate of replies/back-referrals. It was conducted at the Family Medicine Clinic of the Faculty of Medicine, University of Kelaniya. A structured referral letter (form) was designed based on guide lines and literature and it was used for referral of patients for a period of six months. Similarly a structured reply form was also designed and both the referral letter and the reply letter were printed on A4 papers side by side and these were used for the next six months for referrals. Both letters had headings and space underneath to write details pertaining to the patient. A register was maintained to document the number of referrals and replies received during both phases. Patents were asked to return the reply letters if specialists/hospital doctors obliged to reply. Results: Total of 90 patients were referred using the structured referral form during 1st phase. 80 letters (with reply form attached) were issued during the next six months. Patients were referred to eight different specialties. Not a single reply during the 1 st phase and there were six 6 (7.5%) replies during the 2 nd phase. Discussion: This was an attempt to improve communication between specialists/hospital doctors and primary care doctors. Even though there was some improvement it was not satisfactory. A multicenter island wide study should be conducted to assess the acceptability of the format to primary care doctors and specialists and its impact on reply rate
Referral letters from general practitioners to hospitals in Sri Lanka; lack information and clarity
(mediWORLD International, 2013) Ramanayake, R. P. J. C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R. D. N.; Jayasinghe, L.R.; Fernando, K. A. T.; Athukorala, L. A. C. L.
BACKGROUND: Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. In many instances the referral letter is the sole means of communication between general practitioners (GPs) and specialists/hospital doctors. This study was planned to assess the quality of referral letters sent by general practitioners to out patient departments (OPD) of hospitals. METHODOLOGY: This descriptive cross sectional study was conducted in four hospitals of different levels of care provision in Sri Lanka. Referral letters received by the OPDs during a period of 2 weeks were analyzed. A check list to extract data was developed based on the items of information expected in a referral letter and legibility. Each item was assigned a score. This scoring system was validated using a panel of experts by means of Delphi method. Maximum score possible for a letter was 30. RESULTS: A total of 461 letters were analyzed. Items of information most often present were; to whom referred (96.7%), symptoms (91.5%), reason for referral (90.2%) and date (88.9%). The least often present items were; family history (0.2%), history of allergy (1.1%) and social history (1.7%). Most of the words were not legible in 42.3% of the letters. Median score of the sample was 16 (mean=15.69) Mean score of structured form letters was 18.61 (n=33) and in conventional letters it was 15.53 (n=428). The observed difference was statistically significant (z=-3.544, p<0.01). DISCUSSION: Most of the letters did not have the required information and legibility was also poor. Expected benefits of a referral letter to the patient, recipient and the referring doctor will not be achieved due to these short comings. Form letters were comparatively better. Measures should be taken to improve the content and clarity of referral letters.
Structured Referral Form: is it a solution for problems of referral communication in Sri Lanka
(Sri Lanka Medical Association, 2014) Ramanayake, R.P.J.C.; Sumanasekera, R.D.N.; de Silva, A.H.W.; Perera, D.P.
INTRODUCTION AND OBJECTIVES: Referral letters convey information required for continuity of care when patients are referred to a hospital or a specialist. In Sri Lanka conventional, hand written letters are used for patient referrals and there is no standard format or widely accepted guidelines. This study was conducted to explore the acceptability, advantages and limitations of a structured referral form for General Practitioners. METHODS: A referral form was designed based on literature review and guidelines. Printed referral forms were provided to 20 general practices representing different background. Telephone interviews were conducted at the end of 3 months to obtain their views on the format. Interviews were recorded, transcribed and themes identified. RESULTS: It has improved the comprehensiveness of letters and saved time. Overall quality of letters improved and participants were of the view that it could be used in any instance, language competency was immaterial and retrieval of information would be easier. Inadequate space under a few subheadings was a limitation. There was no increase in reply letters after introducing this letter. Participants were willing to use the format in the future as well. CONCLUSIONS: This is a useful and acceptable tool to improve information transfer and it will also be a reminder and guide for doctors to include all information. It could be a solution to the problems of communication in patient relevant in Sri Lanka.
Structured Referral Form; Is it a solution for problems of referral communication in Sri Lanka
(Center for Enhancing Knowledge (CEK), UK., 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.
INTRODUCTION: Referral letters convey information required for continuity of care when patients are referred to a hospital or a specialist. In Sri Lankan conventional, hand written letters are used for patient referrals and there is no standard format or a widely accepted guideline for referral communications. A structured referral form was designed to as a guide for the information to be included, as a solution to the problems in producing a good referral letter (time constrains, competence in language) and to prevent key problemsidentified in letters (omission of vital information, poor legibility and unsatisfactory format). This study was conducted to explore the acceptability, advantages and limitations of the structured referral form for GPs. METHODOLOGY: Referral form was designed based on the guidelines and literature reviews. 20 GPs were purposely selected to represent different backgrounds. Printed referral forms were provided to them and requested to use those for patient referrals for a period of 3 months. Telephone Interviews were conducted at the end of the study period to obtain their viewon the format. Themes expressed by participants were identified. RESULTS: It has improved the comprehensiveness of letters and saved time. Overall quality of letters has improved and participants were of the view that it could be used in any instance, competence in language was immaterial and retrieval of information would be easier. Inadequate space under a few subheadings was a limitation. There was no increase in reply letters after introducing this letter. They were willing to use that format in the future as well. Conclusions: This is a useful and acceptable tool to improve information transfer and it will also be a guide for doctors. It could be a solution to the problems of communication in patient referral in Sri Lanka
Training medical students in general practice : a qualitative study among general practitioner trainers in Sri Lanka
(Medknow, 2015) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.
INTRODUCTION: Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students. METHODOLOGY: This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified. RESULTS: Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge. CONCLUSIONS: GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students.
Training medical students in general practices: Patients' attitudes
(Lesley Pocock medi+WORLD International, 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.
INTRODUCTION: Training medical students in the setting of family/general practice has increased considerably in the past few decades in Sri Lanka with the introduction of family medicine into the undergraduate curriculum. This study was conducted to explore patients' attitudes towards training students in fee levying general practices. METHODOLOGY: Six general practices, to represent different practices (urban, semi urban, male and female trainers) where students undergo training, were selected for the study. Randomly 50 adult patients were selected from each practice and they responded to a self administered questionnaire following a consultation where medical students had been present. RESULTS: 300 patients (57.2 % females) participated in the study. 44.1% had previously experienced students. 30.3% were able to understand English. Patients agreed to involvement of students; taking histories (95.3%), examination (88.5%), looking at reports (96.6) and presence during consultation (88.3 %). Patients' perceived no change in duration (55%) or quality (56.3%) of the consultation due to the presence of students. The majority (78%) preferred if doctor student interaction took place in their native language. 45.8% expected prior notice regarding student participation and two to three students were the preferred number. 93.6% considered their participation as a social service and only 8.8% expected a payment. CONCLUSION: The vast majority of the patients accepted the presence of students and were willing to participate in this education process without any reservation. Their wishes should be respected. The outcome of this study is an encouragement to educationists and GP teachers.
Training undergraduates in general practices: student perceptions
(the Health, 2014) Ramanayake, R. P. J. C; de Silva, A.H.W.; Perera, D. P.; Sumanasekera, R. D. N.; Athukorala, L. A. C. L.; Fernando, K.A.T.